Symptoms and signs of clinical dehydration related to childhood gastroenteritis
symptoms and signs of clinical dehydration related to gastroenteritis
Dehydration caused by acute gastroenteritis is a major concern in the paediatric patients and clinicians must assess the circulatory volume status as part of the initial evaluation in these patients (1).
The following symptoms and signs can be used to detect clinical dehydration and shock. For clinical shock, one or more of the symptoms and/or signs listed would be expected to be present.
Note:
- within the category of 'clinical dehydration' there is a spectrum of severity indicated by increasingly numerous and more pronounced symptoms and signs.
Symptoms indicating category of dehydration of child with gastroenteritis (remote and face-to-face assesssments)
| Clinical dehydration | Clinical shock |
appears well | **appears to be unwell or deteriorating | ------------- |
alert and responsive | **altered responsiveness (for example, irritable, lethargic) | decreased level of consciousness |
normal urine output | decreased urine output | ------------- |
skin colour unchanged | skin colour unchanged | pale or mottled skin |
warm extremities | warm extremities | cold extremities |
Signs indicating category of dehydration of child with gastroenteritis (face-to-face assessments)
| Clinical dehydration | Clinical shock |
alert and responsive | **altered responsiveness (for example, irritable, lethargic) | decreased level of consciousness |
skin colour unchanged | skin colour unchanged | pale or mottled skin |
warm extremities | warm extremities | cold extremities |
eyes not sunken | **sunken eyes | ------------ |
moist mucous membranes (except after a drink) | dry mucous membranes (except for 'mouth breather') | ------------ |
normal heart rate | **tachycardia | tachycardia |
normal breathing pattern | **tachypnoea | tachypnoea |
normal peripheral pulses | normal peripheral pulses | weak peripheral pulses |
normal capillary refill time | normal capillary refill time | prolonged capillary refill time |
normal skin turgor | **reduced skin turgor | ------------ |
normal blood pressure | normal blood pressure | hypotension (decompensated shock) |
Notes:
- dashes (---------) in the tables above indicate that these clinical features do not specifically indicate shock
- ** red flag symptom - may help to identify children at increased risk of progression to shock. If in doubt, manage as if there are symptoms and/or signs with red flags (2).
Suspect hypernatraemic dehydration if there are any of the following:
- jittery movements
- increased muscle tone
- hyperreflexia
- convulsions
- drowsiness or coma.
Reference:
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